Safety and effectiveness of Co-careldopa for motor recovery in post-stroke patients: A Systematic Review

Stroke remains a major global contributor to long-term disability, with motor impairments being among the most debilitating outcomes. Co-careldopa, a combination of levodopa and carbidopa, has been proposed as an adjunct to physiotherapy to enhance motor recovery. However, its clinical efficacy and safety profile are still under investigation. This systematic review evaluates the therapeutic potential and tolerability of co-careldopa in post-stroke motor rehabilitation.

A comprehensive literature search was conducted across PubMed, Google Scholar and Cochrane Library, up to July 2024. Randomized controlled trials and clinical trials comparing co-careldopa to placebo in post-stroke patients were included. Data extraction and screening were performed independently by two reviewers, and methodological quality was assessed using the Cochrane RoB 2.0 tool.

Follow-up periods across studies ranged from 5 weeks to 12 months. Short-term motor improvements were observed, along with reporting significant gains in Rivermead Motor Assessment scores, and another study noting a 79.1% improvement in motor indices among cortical stroke patients versus 49% in controls. However, the largest multicenter trial, found no significant long-term benefit in walking ability. Psychological outcomes showed modest improvements in mood and caregiver burden, while cognitive function remained largely unaffected. Adverse events were infrequent and mild, including nausea and muscle stiffness, with few serious drug-related incidents.

Co-careldopa may support motor recovery in early stroke phases and is generally well-tolerated. Nonetheless, further robust trials are needed to confirm its long-term efficacy and broader clinical utility.